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HomeMy WebLinkAboutBuilding Permit #745-16 - 871 FOREST STREET 12/21/20154,0 �Ou�- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received O�StLE� /6• NC O ti ►v o ..i ermi / NQTA Date Issued: tPOLTAWT: Applicant must complete all items on this page LOCATION �? t GT-, Print �Yr' PROPERTY OWNER A (--,4-7;4 Y- Print 100 Year Structure yes n MAP bi5PARCEL: ZONING DISTRICT: Historic District yes Zn Machine Shop Village yes n� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition [I Two or more family ❑Industrial El Alteration No. of units: El Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ _ _ i Septic D Well _ _.._ .__.i ® Wetlands _� Floolal _._ ❑ Watershedk ®istnct. --.-- Q Watei`/Sewed __ DESCRIPTIUN UI- VVUMK I u tst rr-mrumvir-u. Identification - Please 7 OWNER: Name:_ - cfIyyy Address: 671 ft) -z LS T �Z Contractor Nam or Print Clearly t- I`Phone: Phone: l.( %�r-j -V Address: l,v-N, iqw4a,,,-,2 Miq Supervisor's Construction License: CS — rJ5SZB Exp. Date: Home Improvement License:___Ll to 8 ARCHITECT/ENGINEER Address: Phone: Reg. No li 12�- z0(( - FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 7��v FEE: $ v 0 Check No.: Receipt No.: - NOTE: Persons co tracting with unregistered contractors do not have access lo the aranty fund L -- r— Location O a lY�.c;T Sly No. Date Check #� 29U"41 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ t TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION- Reviewed on - - Signature COMMENTS HEALTH COMMENTS Reviewed on Signature ZoAng Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments V Conservation Decision: Comments Water & Sewer Connection's 7gnature nate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street F REDEPAR+T�MENT*Te' ; ,,.,.... :.._ �: xmpDumpster on"site�Y,yes gym! •:tea?��uto j; Located of 124 MamESt�et `� u, i r, Y3 sF r' �' t.� �n C .tv*�. G +1 „"'�'" .F -p ?9�'�y JCiJ•ai t".r` E4`il� "rt"y•Y 1 S ���+ �It �7°� F 'fit#`S M'i.� ..S T , 1 _��' "r„`^q'p" ,�+ FireDepartment�ignature �y�. }�".i`��{a ��, '�f ,;� s i`. s '�-.` -�'s` �� y�� j ' �l3 1 . sLf ..L�.. v� .-.� +.a•+.+,.� F..._� a't_�.+ � .�..; , "'('y... .i �1. +,. Y a tc #-, ij���9�� `'J +.� a.�ty. !c- s`/'t'r f�•ii♦ iY+ C®MMEp q b F NTS.' f '1� !� !r i »� ,J.� •�y i a.. s ,l r. # tr�Y, :! Y 1�' t 1 �� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-$l000 fine Doc -Building Permit Revised 2014 r -- Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4, Floor Plan Or Proposed Interior Work 4. Engineering Affidavits for Engineered products TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (if Applicable) Engineering Affidavits for Engineered products . OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 75,000.00 m $ - $ 900.00 Plumbing Fee $ 112.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 112.50 Total fees collected $ 1,225.00 871 Forest Street 745-2016 on 12/21/15 Kitchen Remodel a� 0 WN rA F-� �•r LLA 2 LL O O m C Y \ O LL ? N U O_ V7 N z O z o J ca O cu 'O 7 LL L v C U LL O H z O z m = ..0 O m LL O CL (A ? a U ~ W ui L m v U i V) C LL OU a Z v, C7 t �' d' C LL z LLJ 2 a W o uj LL L N i m O z a+ it y N Y O (n w o o O C C O s' � c• O 45 [� W �= F V O v n� 0 Q h ti NG o�`�P w o o O .tit v O C C O O 45 C �a �+- O 0.- 0 v ) aCL N . m m 0 t . 0 8 C c o r v; n � 3 O' J L m M (:> C O CD L N �rO O — 0 CD O O U Q E y- O t d O Z r N O O ' t'N -'•' CD c c H • L CL CLV •N • 0 �, .� Co Q o LCL O r c_ L F- O0. • Q1 — N 0 m W_ _ 'a +�+ O O LL •0 CD Cc N C ' O w E - = v to Q O -a m N '> 4- c 2 �C O` r-O 1- s 4- 4- O_ 0 U .tit v O Quinlan & Rand Builders 34 Trinity Court North Andover, MA 01845 Proposal: Kitchen Renovation Dan & Cathy Ryan 871 Forest Street North Andover, MA 01845 Permit 700.00 Dumpster 62.5:006! — Plumbing & Heating Materials & Labor 6000.00 -Replace 4' baseboard in hall bath -Add 2 toe kick heaters in kitchen -New gas piping to range -Allowances: Kitchen & Island sink $600.00 2 Faucets 500.00 Electrical Materials & Labor 10,000.00 -12 Recessed cans -Under cabinet lighting Cabinets & Appliances (including range hood) by others Granite Materials & Labor 5,000.00 -100 sq. ft. @ $50/sq. ft. Hardwood Flooring Material & Labor 2,700.00 -270 sq.ft. @$10/sq.ft. -1 coat sealer, 2 coats polyurethane Plaster 2,000.00 -Smooth ceiling Paint 1,500.00 -Primer, 2 top coats Building Materials 2,500.00 Q & R Labor and General Contracting 24,000.00 -Removal of cabinets, counters, flooring, walls, & ceiling in kitchen -Removal of hallway ceiling -Removal of 3 windows -Removal of non-bearing wall -Close in existing 4' opening as specified in plans -Frame 2 new casement windows as tight to corner as structurally possible -Install new insulation to exterior walls -Install blueboard -Install finish trim to match existing trim -Add wood blocking for upper and lower cabinets -Install cabinets -install range hood This proposal does not include unseen structural problems or mechanical upgrades. TOTAL $55,025.00 Massachusetts Rome Improvement Sample Contract This Form satisfies all basic requirements of the state's Home improvement Contractor Law (MGL chapter 142A), but does not include standard langdage to protect homeowners. Seek legal advice if necessary. Any person planning ]tome improvements should first obtain a copy of"a ; Massachusetts consumer guide to home improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8797 or 1=888-283-3757. Homeowner InformationContractor InfnrmaHnn Name amp ame Rr-+" C> 17: rLez,: Street Address (do not use a Post Office Box address) Contractor/ Salesperson/ Owner Name ��� I ©tZ�ZS I s� • ti Ing �u�u��v {��i �t9j-�t� City/Town State Zip Code 'C) .' lusiness Address (must includd a street address) i�l. tc�c -� .�A&A � � 3Lt I I�tx. ITy Gam- i , F3/ci�. Daytime Phone Evening Phone ityfrown State Zip Code tt7Qvrt 2 /vl U 1 �juS— Mailing Address (It different from above) usioess Phone ederal Employer ID • _ lamrequires oatmart home im- plaV=emt contractor; have l orS.S. Number Home ve proma7dEeonactar see. Number Hx*nan date The Contractor agrees to do the following work for the Homeo sad R�IchCahoo n1IIOF�Cf ner: . em OEM Ia r o mpee sP g e e, r r �L Av( t -k -h- (L T Requlred.Permlts - The followingbuilding permits are required and v`rill be secured by the contractor as the homeowner's agent, (Owners who secure their own permits will be excljlded from the Guarant3% Fund provisions' of MGL chapter 142A.) ' Total Contract Price and Pavment Schedule - t13�•'E'hJ Proposed Start and Completion Schedule - The following schedule will be adhered to unless circumstances beyond the coutractot's control arise LZ 222 Date when contractor will begin contracted work. . i_Z1_r_ /____Date when contracted work will be substantially completed. The Contractor agrees'to perform the work, famish the material and laborspecified above for the total sum of: �� SU Payrtjents will be made according to the following schedule: upon signing 'conttact (riot to exceed 1/3 of the'total contract price orthe cost of'special order items, whichever is greater) s ��3 by /�/� or upon completion -of W#Xll f by /_/_ . or upon completion of $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to bothparty's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted wari'begins in order $ to be paid for to meet the completion schedule.(**) • NOTES: (*) Including all finance charges (**) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special dtderedin advance to meet the completion schedule, Express Warreoh As an express warr><irty beim roylded by the contract rtr? No Yes all terms of the warranty must he attached to the contrectl Subebntractors - The't;ontr-actor agrees to be solely responsible for completion of the work described regardless of the actions of any third paity(subcontmctor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for Matedais and labor under this aar'eement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it Ask questions if something is unclear. • ' Make sure the contractor has a valid Home improvement Contractor R.onistration 'The law requires most home improvement contractors and subcontractors to be registered with the Director of Horne Itnprovement Contractor Registration You may inquire about contractor registration by writing to the Director at One Ashburton Place, Ruom 1301, Boston, MA 02108 or by calling 617-727-3200 or 1=800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home• Improvement Contractor Law. You may cancel this agreement if it has been signed at a plea; other than the contractor's. normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of die third business day following, the signing of this agreement See the attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESH I Two identical copies of the -contract must be completed and signed. one copy should go to. the hoineowner. The other copy should be kept by the contractor. Homeowner's Signa re Contractor' ignature Date Iz ZCy Date t/ . Contractor Arbitration The Home Improvement Contractor Law provides homeowners with'the right to initiate an arbitration action (as an . alternative to -court action) if they have a dispute'with a contractor. The same right is not automatically affordeq to a' contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in'the event the contractor has a dispute concerning thin contract, the contractor may submit the dispute to a private arbitration ficin which has been approved. by the Secretary of the, Executive Office. of Consumer Affairs and Business Regulation and the consumer shall. be required to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A. Homeowner's Signature Contractor's Signature NOTICE: The signatures of the parties above apply only to the agreement of the parties. to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (i.e. MGL chapter 93A) .may not be waived in any way, .even by agreement' However' homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law, 'Homeowners who secure their own building permits aro automatically excluded from all Guaranty. Pund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and workmanlike meaner. Homeowners may be entitled'to other specific Legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided,by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose,' An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the term's of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions) about Your consumer/homeowner rights, contact the Consumer Information Hotline (listed below). Execution of Contract ,. The contract must be executed in du documents have been.licate and should not be signed until. a copy of all exhibits and referenced attached . Parties are -also advised not to sign the document until allblank sections have been filled in or marked as'yoid, deleted, or not applicable. One original signed copy of the contract with attachments is to lie given to the owner`and the other kept�by the contractor. Any modification to the original contract must be in writing . and agreed to by both parties. Contracted work may not begin until both parties the contract,. and the three day recission period has expired. have received a 1uIly executed copy of ''-- - -Accelerated.lrayments- A contractor may not demand'payments in advance of the dates specified on the payment schedule in cases wire homeowner deems him herself to be frriancially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed d a joint escrow account as a prerequisite to continuing the contracted work, Withdrawal of funds from said account would require the signatures of both parties. Additional Information If u have consumer rights,. general questions you wish to need additional information about the Home Improvement Contractor obtain a free co of A Consumer Guide.to the Home Improvement Contractorr Law," contact: � PY.... Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787'or 1-(8-88) 2833757 If you want to verify the registration of a contractor or if you have questions or need about the contractor registration component of the Home'Improvement Contractor Law ' ed additional information specifically colttact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One -Ashburton Place, Room.1301, Boston, MA 02108 (617) 727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints a against business, g usrness, call: Consumer Complaint Section Office of the Attorney General (617) 727-8400 ANIS/OR Better Business Bureau (508) 652-4800 (508) 755-2548 (413) 734-3114 q _ o� k � q $ § k q � � Q � U�k § � 0 . cd \ � o � / th � \ , m/ § � 0 d '§ 0 � u § 0 q \ Cdk �4-j � � § § 0 § \ Cd Cd X08„ 50.' 0,'e j 830SSWCM Fj30SSWCM -v Mi. o mid v v oes� a�Za ... 21068 L 0 U 00 L9 ti N i �s U nitl O N10 � O P zN m N 4 m b Qa a � Cl) ' { O N E � 0 1 � U � N 'd AL Cl)..co c -M u Lo LL t... 0. 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Cd 0 � 'G bb cd U U Un m o ,b U v1 � U `n N bb Ua� ,000 Cz cn .4 4-4O U cn rig En Cd �d��b L r N O �n y U N � Z to Q a Q .b cn o W � � b Cd Cd . ... U O U � 0 � O � 'b , 'd 0 ¢Q'' Homo b U U O � ebb � 3-� U —4 Ua� cn .000 to o Nbb E 0 NO �N � N O �~ z N Qa Q W g1(6o-3 The Commonwealth of Massachusetts - Department of Indushial Accidents Office of Investigations kqjp 600 Washington Street Boston, MA. 02111 www.massgov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual):, Bal Address: (Z I N l T -Y (il' City/State/Zip: Al.- NQQy6A in A olg gone #: -o5'U Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I _ ployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have worldng for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roofrepairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 1 "Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providi g workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name% e 1 b _e�" U �L Policy # or Self -ins. Lic. #: ExpirationDate: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert, fy under thepAins andpeotles ofperjury that the information provided above is true and correct. Phone #: � / (9—his? x"452& Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer`is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a -deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current PORGY information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Revised 5-26-05 The Commoixwealtb of MassachvsPt€s Depa,d ent o1; h1dustdal Accidents Qf oe o1; Iuvestigatious 600 Washington Street Boston, MA 02111 Tel # 61.7-727-4900 at 406 or 1-877-MASSAFE Fax # 617-727-7749 www.Mass,gov/dia CoRffCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YM) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endoreement(s). PRODUCER COSTELLO INSURANCE AGENCY CONT NAME: Emily Costello PHONE 978.374.6352 F°x IAC la- 00 F10.97e.521.5127 2 South Kimball St. F.-MAIRE3.ecostello@costelloinsuranca.com PO Box 5248 Bradford MA 01835 INSURERS AFFORDING COVERAGE NAIC0 INSURERAMerchants Mutual 23329 INSURED Quinlan & Rand Contractors INSURER B -kZM Insurance Co. 33758 34 Trinity Court INWRERC: NO Andover, MA 01845-4248 INSURERD: INSURER E GENT AGGREGATE LIMIT APPLIES PER: 7X POLICY PRO. LOC INSURER F: $ vvn,...Iv a..cR,u-u�w,�rvu,u,rc�,e•e Vta - LU1n ocv, Q,�uwu�een. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIAEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICYNUMR POJDDY� POLICYEXP LIMITS A GENERAL LIABILITY COMMERCIAL GENERrA�L--I�,IABIUTY CLAIMS -MADE L X 1 OCCUR SOP1064274 3/12/2015 03/12120-16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea otxwronla $ 500,000 MED EXP (Any one person) $ 15,000 PER80NAL 8 ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: 7X POLICY PRO. LOC PRODUCTS - COMP/OP AGG S 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED 61NOLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per socMern) PROPERTY DAMAGE eld UMBRELLA LIABOCCUR EXCESS LIAB HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DIED 1 1 RETENTIONS $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERrEXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If dLinder yyes dRIPosca3pa Linder OF OPERATIONS below N/A irWC10060152792024A 3/08/2015 9/08/2016 VvMCSTATU LIMIT: E.L. EACH ACCIDENT $ 100,000 6,L. DISEASE - E4 EMPLOYE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEMICLES (Atlnah ACORD 101, Additional Remarks Scrleclule, U more space Is requlmd) Partners Quinlan & Rand have elected to be excluded from Worker's Compensation coveraga. (978)688-9542 Town of North Andover 120 Main street North Andover, MA 01845 A/�AOII AC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Costello/HOYECI L- "_-'�- -� •� ��► Ts) IVOU-201U ACORD CORPORATION. All rights reserved. INS026 (zoloos).o1 The ACORD name and logo are registered marks of ACORD Massachugetts-- Bepartmeht of Public Safety Board of Building.f2egulatioris and Standards - Construction Supen-isor j License: CS -055288 TIMOTHY R 1 ST. ONGE EitERT� ' Haverhill MA 01$30 v Expiration Commissioner 03/05/2016 r -- ry'•��"—""�-.. Office of Con§um r Affairs & Business Regulation License or registration valid individul use OT�IE IMPROVEMENT CON TRACTQR P before the expiration date. If found return use only egistration: `111089, Expiration 11/25/2016 Type' Office of Consumer Affairs and Business Regulation. `- �� _ i r Partnership � 10 Park Plaza - Surte 5170 QUINLAN &RAND FiUILDERS- l r ° ; 'Boston,'MA 02'116 i TIMOTHY QUINLAN td 34 TRINITY CT NIANDOVER; MA 01845F�~� Urlersecretary.— No vali with;QU. 'signature }'